2. ELABORACIÓN DE LA PROPUESTA DE TRABAJO DE GRADO
2.1. PLANTEAMIENTO Y FORMULACIÓN DE PROYECTOS
2.5.8. Procedimiento de la investigación
(AC/AE)
assimilating (AC/RO)
Note. McLeod, S. A. (2010). Kolb's learning styles and experiential learning cycle - Simply psychology. Retrieved from
Appendix G
TELS Model of Simulated Learning©
Note. Transformational Leadership and Experiential Learning through Simulation (TELS). Created by C. Delucas, November 18, 2013.
Transformational
Leadership
Simulation
Experiential
Learning
Appendix H Analysis of Participants
Title Setting Role
Yrs. Prof Years Responsibilities Other experience Scenario ANM HMO 18 mos. 24 years Day-to-day oversight of unit. Patient placement; staff resource; rounding; service recovery’ involvement in budget,
quality and projects; evaluations; attendance
reviews; disciplinary process; manage 16
staff.
N/A L
ANM HMO 2 years 33 years
Day-to day coordination of admitting and recovery
of OR patients
N/A C
ANM HMO 2 years 10 years
Daily management of nursing units.
CNA 10 years C ANM HMO 3 years 13
years
Unit facilitator, coordinator. Advocate
for both patients and families, and staff.
Staff nurse C
Interim Mgr
HMO 1 mo. 23 years
Daily operations, staff and budget oversight
Medical assistant I ANM HMO 8 mos. 17
years Maternal-Child Health – no delineation of responsibilities 1 years as a high school teacher and 2 years as a computer programmer C
ANM HMO 5 years 11 years
Staffing, performance monitoring, coaching, budget responsibility with regard to staffing
5 years as CNA L
ANM HMO 3 years 28 years
Manage front-line staff/shift; budgeting at
the staffing level
Staff nurse, nurse anesthesia
I
Nurse Mgr Magnet 9 mos. 13 years Manager, L&D/Mom- baby Staff RN, Clinical coordinator L Nurse Mgr Magnet 1.5 years 14 years 24/7 responsibility of Rehab/Orthopedic Staff nurse T
floors Nurse Mgr Magnet 16 mos. 25+ years Med/Surg 141 Employees Bedside, Clinical Coordinator PS Nurse Mgr Magnet 2 years 17
years
Manager of Progressive Care Unit,
Cardio-Pulmonary ICU, Staffing, Cardiac
Monitors Techs 2 years retail department store I Mgr Pharm. Co. 5 years 11 years R&D. Administers global grants program
for healthcare Researcher, healthcare consulting, Bio- technology, Pharmaceuticals T Mgr Pharm. Co. 3 years 10 years Manage of team of 2. Perform literature surveillance of scientific information and communicate findings to stakeholders Pharmacy technician, Bio- technology PS Sr. Mgr. and Pharmacist Phar. Co. 7 months 13 years Medical Information Team Lead. Lead a
team of 6 on-site managers, 2 admins, third party call center
Retail pharmacy, pharmacy tech
and clerk
C
Appendix I
USF IRB Approval
November 13, 2012 Dear Angeline Christine Delucas:
The Institutional Review Board for the Protection of Human Subjects (IRBPHS) at the University of San Francisco (USF) has reviewed your request for human subjects approval regarding your study. Your study has been deemed to be exempt
from IRB review based on the following conditions:
Unless otherwise required by department or agency heads, research activities in which the only involvement of human subjects will be in one or more of the following
categories are exempt from this policy:
1) Research involving the use of educational tests (cognitive, diagnostic, aptitude, achievement), survey procedures, interview procedures or observation of public behavior,
unless: (i) information obtained is recorded in such a manner that human subjects can be identified, directly or through identifiers linked to the subjects, and (ii) any
disclosure of the human subjects' responses outside the research could reasonably place the subjects at risk of criminal or civil liability or be damaging to the subjects'
financial standing, employability, or reputation. This application does not require IRB review.
On behalf of the IRBPHS committee, I wish you much success in your research. Sincerely,
Terence Patterson, EdD, ABPP
Chair, Institutional Review Board for the Protection of Human Subjects ---
IRBPHS – University of San Francisco Counseling Psychology Department
Education Building – Room 017 2130 Fulton Street San Francisco, CA 94117-1080 (415) 422-6091 (Message) (415) 422-5528 (Fax) [email protected] --- http://www.usfca.edu/soe/students/irbphs/
Appendix J
Appendix K
CSA SWOT Analysis
Strengths
• Meets goals of interprofessional education (nurses and other healthcare professionals)
• Low cost for CSA
• Adds leadership scenarios to library filling the existing gap
• Provided updated leadership template for CSA subscribers and faculty to utilize
• Increased awareness that simulation is not all high tech, but highly effective
• Does not require a high tech simulation center
• Appeals to all levels and types of healthcare organizations
• Multi-media potential – appeal to younger generations
• May be used by individuals or groups
• Adds leadership content expert to faculty
Weaknesses
• May not be considered high fidelity for those interested in mannequin
simulators
• Requires actors
• Lack of understanding of importance
• Need to communicate the relevance of simulation in leadership and the potential uses
Opportunities • Increase in subscribers
• Advances full scale high fidelity simulation
• Enhances CSA role in leadership development
• Assist organizations in improving patient safety through enhanced leadership education
Threats
• Organizations may think that it will increase their educational expenses
• Availability of scenario authors and commitment to complete scenarios
• Competition from major national organizations such as the National League for Nursing
Appendix L
CSA Incremental Financial Projections for Leadership Scenario Sales
Table K1. CSA Subscriber Rates - 2013
Subscriber California Out-of- State
Individual $75.00 $350.00
Facilities $350.00 $1000.00
Note. Fees as described on CSA web-site: www.californiasimulationalliance.org
Table K2. CSA Three Year Projection for Incremental Revenues
2013 2014 2015 2016 3 year incremental sales Revenues – CSAa California- Individual 225 450 675 1350 California- Facility 1750 3500 5250 10500 Out of state - Individual 700 1400 2100 4200 Out of state - Facility 1000 2000 3000 6000 Total-gross 3675 7350 11025 22050 Expenses- CSA Validation & Testingb 0 400 400 400 1200 Videographyc 500 250 250 250 750 Marketing 1000 1000 Total 500 1650 650 650 2950 Net Revenues 2025 6700 10375 19100 Expenses- Student
Taxi to/from airport to home
31 Airfare 469 Hoteld 2,260 Mealsd 887 Rental car expenses 187 Tolls & Parking 40 Actors- remuneratione 72 Sponsor Expenses 140 Validation & Testingf 0 Videographye 25 Participantse 373 Total 4484
Note. aCSA subscriber revenues are based on 2013 rates (see Table K1). bValidation and testing rates at $50/hour at 4 hours per scenario.
cVideography at $125 per hour at 2 hours per scenario. dBased on government allowed per diem rates. eProvided in the form of gift cards. fIn-kind provided by the California Simulation Alliance.
Appendix M
Appendix N
Synopsis of Project
Clinical leadership is fundamental to the success of a health care organization as it strives to achieve identified strategic goals (Kanste, 2008). Leadership is comprised of “hard” skills (e.g., business planning, budgeting) and “soft” skills, human attributes. Upenieks (2003) and Kanste (2008) findings indicate that transformational leadership behavior predicated upon influence, inspirational motivation, and intellectual stimulation along with traditional rewarding affects the leader’s feelings of personal
accomplishment.
There is a broad range of definitions for leadership; however the simplest is the ability to influence others to achieve goals (Kanste, 2008; World Health Organization, 2009; Government
Accounting Office, 2010). Kotter (1990) states that leadership involves providing the organization with a strategic vision; communicating that vision to the employees; and, inspiring, motivating and aligning staff to achieve the vision. Leadership is not an intrinsic quality, but is comprised of a diverse collection of competencies, personal attributes and vision requiring education, leadership development and mentoring (Hughes, 2009).
This project is centered on identifying the human factor attributes (“soft” skills) that epitomize successful leaders. Initially, a survey utilizing convenience sampling of attendees at the 2013 AONE conference was utilized to identify five key “soft skills” that attendees indicated were necessary for successful leadership. This was followed up with the same survey being distributed via Survey Monkey™ to the following constituents: University of San Francisco DNP students and faculty, Doctors of Nursing Practice list serve, and an array of healthcare professionals known to the author. Once the surveys are analyzed, initial scenarios will be developed, validated and tested prior to implementation. While nurse leaders were the initial focal point, the simulations are being designed for inter-professional education and development.
The University of San Francisco IRB has reviewed and approved the project as qualitative in nature. Prior to implementing the scenario simulations, the scenarios will be validated and tested in collaboration with the California Simulation Alliance. Dr. KT Waxman is involved as advisor to the DNP student and is a recognized simulation expert. Clini-Space™ leaders have agreed to have the student develop virtual reality scenarios utilizing their platform as web-based precursor study sessions, prior to implementation of “live” scenario implementation.
Organizations that agree to participate in the initial phases will be asked to identify participants, preferably on a voluntary basis. The participants will be apprised of the process, questions answered, and simulations will occur on-site or in each organization’s simulation center. Based upon feedback from the organization’s leadership, the implementation site will be determined ahead of time. It is estimated that scenarios including pre-briefing and debriefing should average 1-1 ½ hours. An evaluation process will be developed and provided to the organization to use in determining the effectiveness of the simulation education. Follow-up and participation in the evaluation by the DNP student will be accomplished through mutually agreed upon methods (e.g., Webinar, Skye, on-site). Feedback from participating organizations is imperative for improving scenarios, updating them, and for future development of additional scenarios pertaining to other “soft” skills.
References
Kanste, O. (2008). The association between leadership behavior and burnout among nursing personnel in health care. Nursing Science, 89(28)3, 4-8.
Kotter, J. (1990). A force for change, how leadership differs from management. New York: Free Press. Upenieks, V. (2003). Nurse leaders’ perceptions of what comprises successful leadership in today’s acute
inpatient environment. Nursing Administration Quarterly, 27(2),140-152.
Appendix O Leadership Template
Appendix P
Appendix Q
On-site Evaluation Questions
Was this beneficial to you? Explain your answer.
What suggestions do you have for improvement in the process?
Would you use simulation as a self-directed process for learning, and if so, how?
Would you recommend leadership simulation as an additional process for leadership development?
For those participating in the listening and integrity scenarios, they were asked whether they would review and comment on the virtual reality scenarios that were developed. If so, the request was that they provide information back regarding the use of them as a study guide pre or post participation in a simulation experience.
Appendix R
Appendix S
Top Five “Soft” Skills by Group
Collective Group Integrity 55 Communicative 53 Team Building 47 Listening 29 Problem Solving 28
Chief Nurse Group
Team Building 7
Communicative 6
Integrity 5
Problem Solving 5
Negotiating 4
Deans and Associates
Communicative 6 Integrity 5 Trustworthy 4 Work Ethic 4 Problem Solving 3 Integrity Communicative Team Building Listening Problem Solving Team Building Communicative Integrity Problem Solving Negotiating Communicative Integrity Trustworthy Work Ethic Problem Solvong
Directors and Managers Adaptability/Flexibility 16 Communicative 14 Integrity 13 Listening 11 Team Building 11 Staff nurses Communicative 8 Team Building 7 Adaptability/Flexibility 6 Integrity 4 Trustworthy 4
Note. When viewing the online version, hovering over each section of the pie provides the value and percentage of each skill. Value equates to combined total of the times the skill was selected by the survey participants.
Adaptability/Flexibility Communicative Integrity Listening Team Building Communicative Team Building Adaptability/Flexibility Integrity Trustworthy
Appendix T
Respondent Answers to On-site Evaluation of Simulation Experience
Question Respondent Answers
Was this beneficial to you? Explain your answer. “It was realistic and good to do with other than friends who tend to reinforce rather than give honest feedback.” Liked the tools for de-escalation. Made you be more aware and “open your eyes to see things differently>’ Tips for communication were helpful.
“Very much. You tend to get into a routine, forget things. A good reminder.”
Realistic. Good to do with other than your friends who tend “to reinforce rather than give honest feedback.” Realistic, isn’t pretend.
Very realistic. Helped think of different ways to phrase things, to think through, think improvement.
Realistic. Gave concrete examples in debriefing. “Tips for de- escalation helped to determine dealing with difficulty, looking at hearing versus listening.”
“Oh yes. In other simulations, people got caught up in acting so it wasn’t as beneficial (realistic).” Flow exchange and feedback. “When people know each other, they’re timid, all good, rather than feedback for improvement.”
Adds variety to learning, puts in real life versus role play that you know ahead of time. Beneficial for someone in my position (assistant nurse manager). Like simulation; see what others are doing. Some fear due to judgment/role modeling. Simulation – “you know, it’s not threatening, mirrors real life. Felt the pressure even though acting. I had to think about how to respond.”
Good to hear again. Have never been in live simulation, very good, forced to think quickly, think about being in the situation. Debriefing, forming, organization and team discussion.
Able to identify what to do; step back and check perceptions of colleagues up and down the chain. Realistic, want to find the real answer.
Gained tools, used some tactics.
In the moment. Learning for the future, debriefing provided immediate feedback.
Simulation – the best way to learn, realistic. “Good to have people you don’t know because your own people know you.” What suggestions do you have for improvement in the
process?
Two answered no without further explanation No, low key and not intimidating.
No, comfortable atmosphere, encouragement and constructive criticism.
Add reflection in debriefing to past experience
Seven wanted more information about the scenarios, know ahead of time.
One preferred to have an employee level actor rather than facilitator as well as knowing more about the scenario.
Tighten role/scenario. More props.
Would you use simulation as a self-directed process for learning, and if so, how?
“Prefer being a participant. Just watching, you don’t get the feel.”
Yes, and participation. “Can capture the essence through videos; virtual worlds could be helpful”. Additions including books with case studies at the end of each chapter.
“Prefer live interaction and feedback is really important.” Videos and vignettes as a study guide, not a replacement. “Yes, but would be live scenarios with immediate debriefing.” “Yes, I do all the time, like change.” Prep using self-directed in learning. Read articles. “Interactive avatars sound
fascinating.”
“Yes. Historically/currently, I feel a little alone, as you go up the chain, limited communication for support.” Do at a time and place that’s suitable and pre-planned.
Would you recommend leadership simulation as an additional process for leadership development?
All responded yes. Not all elaborated.
“Yes, particularly because a lot our classes are good but are run by non-nurses versus someone who has lived it and
understands the subtleties and knows the people part, patient safety, and clinical. We all drift into clinical and non-nurses don’t understand and people don’t get the disconnect. When challenged, it’s fun for them, but we don’t get more out of it.” “Yes, number 1. Self-learning a little.”
“Absolutely – especially the feedback part.” Like the application and then the immediate feedback.
“Oh yes, absolutely. You get real time feedback, rather than vignette when you can figure out the right answer.”
“Definitely. It’s important to be in the hot spot so you learn. The best part was the safe environment.” You can increase complexity and make it more challenging.
“Yes, leadership courses, classroom, videos, readings for OJT - hard to get done while working with the outside pressure. This gives you time to do, to participate.”
“Yes. Would like more.” Supplements growth. “Can use in daily life as well, good learning, good in early career.”